Breast Cancer Overview and Treatment
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Questions and Answers

What is the most common type of breast cancer?

  • Ductal carcinoma in situ
  • Phyllodes tumor
  • Adenocarcinoma (correct)
  • Lobular carcinoma

What genetic mutations significantly increase the risk of breast cancer?

  • APC and XRCC2
  • TP53 and PTEN
  • HER2 and MMR
  • BRCA1 and BRCA2 (correct)

Which of the following factors is NOT a risk factor for breast cancer?

  • Obesity
  • Family history
  • Early menarche
  • Frequent exercise (correct)

What are the two types of post-mastectomy breast reconstruction?

<p>Prosthetic implant-based and autologous tissue-based (D)</p> Signup and view all the answers

Which factor would NOT influence the choice of reconstruction technique?

<p>Patient's history of hypertension (B)</p> Signup and view all the answers

What is a key advantage of skin-sparing techniques in breast reconstruction?

<p>Improved symmetry after reconstruction (D)</p> Signup and view all the answers

What is the primary purpose of placing a tissue expander in a two-stage reconstruction?

<p>To minimize tension on the mastectomy flap until desired volume is achieved (A)</p> Signup and view all the answers

What is a potential limitation when using latissimus dorsi myo-cutaneous flap in breast reconstruction?

<p>The availability of sufficient donor tissue (D)</p> Signup and view all the answers

During the second-stage procedure of a two-stage reconstruction, what is commonly performed to enhance breast aesthetics?

<p>Capsulotomy to increase breast projection and ptosis (D)</p> Signup and view all the answers

What does the duration of implant-based breast reconstructive surgery typically range from?

<p>2 to 9 hours (A)</p> Signup and view all the answers

What is the primary benefit of using autologous tissue for breast reconstruction?

<p>More natural appearance and consistency (C)</p> Signup and view all the answers

Which procedure allows for the largest amount of tissue transfer in breast reconstruction?

<p>Free TRAM flap (B)</p> Signup and view all the answers

What is a significant disadvantage of autologous tissue reconstruction?

<p>More complex surgical procedure (D)</p> Signup and view all the answers

Which of the following factors would likely increase the risk of TRAM flap failure?

<p>Smoking (C)</p> Signup and view all the answers

What technique does the DIEP flap utilize to enhance perfusion and minimize donor site morbidities?

<p>Dissecting tissue while preserving muscle (B)</p> Signup and view all the answers

What is the typical duration range for a TRAM flap surgery?

<p>5 to 12 hours (D)</p> Signup and view all the answers

Which statement about the pedicle TRAM flap is accurate?

<p>It maintains blood supply via the superior epigastric artery. (A)</p> Signup and view all the answers

Which comorbidity is NOT associated with increased mortality from breast cancer?

<p>Hyperlipidemia (D)</p> Signup and view all the answers

What is a primary reason that complicates anesthetic management in obese patients undergoing breast surgery?

<p>Decreased airway compliance (D)</p> Signup and view all the answers

Which statement accurately reflects the effects of obesity on the cardiovascular system?

<p>Hypertension with obesity can result in concentric hypertrophy. (D)</p> Signup and view all the answers

How does obesity impact the respiratory system in patients undergoing anesthesia?

<p>Airway closure can lead to arterial hypoxemia. (B)</p> Signup and view all the answers

What impact does advanced age have on breast cancer incidence?

<p>Increases the risk, especially in women over 65. (B)</p> Signup and view all the answers

Which of the following is NOT a negative consequence of obesity on anesthetic management?

<p>Increased pulmonary compliance. (B)</p> Signup and view all the answers

What endocrine-related issue is more likely to occur in obese patients?

<p>Altered glucose metabolism (D)</p> Signup and view all the answers

What is a potential outcome of small doses of Adriamycin in patients undergoing surgery?

<p>Acute myocardial dysfunction (D)</p> Signup and view all the answers

Which anesthetic consideration is crucial for patients treated with Adriamycin?

<p>Comprehensive preoperative cardiac evaluation (C)</p> Signup and view all the answers

What is a major concern associated with the use of Adriamycin during anesthesia?

<p>Decreased myocardial performance (D)</p> Signup and view all the answers

For patients with bilateral mastectomies, what alternative site should be considered for IV placement?

<p>Lower extremity (D)</p> Signup and view all the answers

What is the estimated frequency of significant cardiomyopathy in patients receiving less than 450 mg/m² of Adriamycin?

<p>1% to 10% (D)</p> Signup and view all the answers

Which of the following statements about the anesthetic management for patients treated with chemotherapeutic agents is true?

<p>Cardiac function should be monitored due to potential drug interactions. (D)</p> Signup and view all the answers

What physiological effect does hypothermia have on flap reconstruction during surgery?

<p>Causes vasoconstriction and restricts blood supply (B)</p> Signup and view all the answers

Which of the following is a potential risk associated with the use of dextran during flap reconstruction?

<p>Decreased hemostasis (D)</p> Signup and view all the answers

In what position should a patient typically be placed to harvest the latissimus dorsi flap?

<p>Lateral decubitus (A)</p> Signup and view all the answers

What should be prioritized to prevent complications when the patient is moved to a sitting position during surgery?

<p>Keeping the endotracheal tube secure (C)</p> Signup and view all the answers

How can the emergence from anesthesia be impacted by hypothermia post-surgery?

<p>Decreased hepatic drug metabolism (C)</p> Signup and view all the answers

What complication may arise from abrupt positioning changes during breast reconstructive surgery?

<p>Increased risk of nerve injury (B)</p> Signup and view all the answers

What is the primary reason to maintain mean arterial pressure within 20% of preoperative values during TRAM flap procedures?

<p>To ensure adequate perfusion pressure to the flap tissue (C)</p> Signup and view all the answers

Which factor is most relevant when determining the need for blood or plasma transfusions during reconstructive breast surgery?

<p>The patient's preoperative physical status and hemodynamic stability (C)</p> Signup and view all the answers

What is a significant potential complication associated with autologous blood donation prior to surgery?

<p>Higher rates of postoperative transfusion due to preoperative anemia (D)</p> Signup and view all the answers

Why is the use of nitrous oxide discouraged during TRAM flap reconstruction?

<p>It can lead to abdominal distention and compromise cosmetic results (D)</p> Signup and view all the answers

What is a significant drawback of administering large volumes of crystalloid fluids during surgery?

<p>It may increase the risk of fluid overload (C)</p> Signup and view all the answers

What impact does hypertension have during the TRAM flap procedure?

<p>It frequently causes excessive bleeding (B)</p> Signup and view all the answers

When considering hemostatic factors during surgery, which laboratory values need to be monitored most closely?

<p>Serial hemoglobin values and coagulation profiles (D)</p> Signup and view all the answers

What is the most significant advantage of using a thoracic paravertebral nerve block in the postoperative period?

<p>Promotes deep breathing to prevent atelectasis (D)</p> Signup and view all the answers

What common reason necessitates the reintervention of breast implants over the years?

<p>Development of contractures, migration, leakage, or rupture. (B)</p> Signup and view all the answers

During the postoperative period, which of the following practices is crucial to prevent atelectasis?

<p>Encouraging deep breathing exercises to inhibit sympathetic hyperactivity (C)</p> Signup and view all the answers

What is a major consideration when managing postoperative pain, particularly regarding narcotic administration?

<p>Continuous monitoring is essential to prevent respiratory depression. (D)</p> Signup and view all the answers

Flashcards

Breast Cancer Risk Factors

Factors that increase the chance of developing breast cancer, including family history, early menarche, and obesity.

Breast Cancer Types

The different kinds of breast cancer, with adenocarcinoma being the most common, starting in milk ducts or lobules.

Prophylactic Mastectomy

Preventive surgery to remove the breasts; done in some women with high breast cancer risk due to BRCA genes.

Post-Mastectomy Reconstruction Types

Two ways to reconstruct a breast after removal, using implants (prosthetic) or the patient's own tissue (autologous).

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Breast Reconstruction

Surgery to rebuild the breast after cancer treatment or mastectomy.

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Single-stage implant reconstruction

A breast reconstruction method using an implant in a single procedure. Suitable for smaller breasts.

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Two-stage tissue expander reconstruction

Breast reconstruction using a temporary expander followed by a permanent implant, taking place over two surgical procedures.

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Combined implant and autologous tissue reconstruction

A breast reconstruction technique that combines an implant with tissue from another part of the body, most commonly the back, to rebuild the breast.

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Skin-sparing technique

A reconstructive surgery technique that preserves the breast's skin envelope, aiding in better symmetry after reconstruction.

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Tissue expander

A temporary inflatable device placed under the breast during reconstruction to gradually increase breast volume.

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Autologous Tissue Reconstruction

Breast reconstruction using the patient's own tissue.

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TRAM Flap

A breast reconstruction technique using tissue from the abdominal wall.

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DIEP Flap

Breast reconstruction technique using tissue from the lower abdomen, minimizing donor site issues.

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Pedicle TRAM flap

The blood supply of abdominal tissue is preserved, blood vessels to the chest are reconnected.

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Free TRAM Flap

Blood supply of abdominal tissue is temporarily disconnected until it's reattached to the chest.

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TRAM Flap Duration

Process can take between 5 to 12 hours (average 7.5 hours).

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TRAM Flap Failure Risk

Conditions like obesity, smoking, and radiation treatments increase risks of procedure failure.

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Latissimus Dorsi Flap

Breast reconstruction technique involving tissue from back.

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Obesity and Breast Cancer

Obesity increases breast cancer risk due to higher estrogen production and negatively impacts wound healing and flap complications during reconstruction.

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Obesity and Anesthesia

Obesity complicates anesthesia by affecting multiple organ systems, including cardiovascular (heart problems), respiratory (breathing difficulties), and endocrine (diabetes risk), needing careful management.

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Obesity and Respiratory Issues

Obesity reduces lung capacity and chest wall compliance making breathing harder and increasing risk of hypoxemia (low blood oxygen) during and after surgery.

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Obesity and Cardiovascular Risks

Obesity is linked to cardiovascular diseases like hypertension and coronary artery issues, increasing risk of heart complications during surgery, a critical factor.

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Comorbidities in Breast Cancer

Diabetes, kidney problems, stroke, liver disease, and prior cancer increase breast cancer mortality, especially with older age, as these can negatively impact recovery, and even cause complications during surgeries.

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Pre-Op Considerations in Obesity

Careful pre-operative evaluation focusing on cardiovascular and respiratory function in obese patients is crucial for safe anesthesia.

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Smoking and Breast Reconstruction

Smoking negatively impacts wound healing and increases chances of flap failure in breast reconstruction, post-surgery.

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Pre-oxygenation Importance

Crucial in obese patients before anesthesia to reduce the risk of low blood oxygen levels (hypoxemia), critical to prevent respiratory complications during surgery.

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Adriamycin's cardiotoxicity

Adriamycin, a chemotherapy drug, can damage the heart, potentially causing acute or chronic myocardial dysfunction. Severity depends on dosage.

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Anesthetic implications of chemo

Chemotherapy drugs like Adriamycin influence anesthetic plans due to potential interactions with the heart and other organs.

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Cardiomyopathy risk

The risk of significant heart damage (cardiomyopathy) from Adriamycin is estimated between 1% and 10% if total dose is less than 450 mg/m².

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Preoperative cardiac evaluation

A comprehensive assessment of the heart's health is essential before breast surgery in patients who have received chemotherapy, especially if Adriamycin was used.

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IV placement considerations

Avoid IV placement or blood pressure monitoring on the mastectomy side, especially if bilateral lymph node dissection occurred.

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Arterial line placement

Arterial lines may be beneficial for patients with heart disease, anemia, lymph edema or other factors for accurate real-time blood pressure monitoring.

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Avoid lymph edema

Positioning IVs or monitoring blood pressure on the affected side of a mastectomy can cause lymph edema.

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Anesthetic considerations for a chemo patient

Patients undergoing reconstructive surgery, particularly those with a history of chemotherapy, require careful anesthetic management, taking into account the potential damage to heart and other organs due to the drugs used to treat cancerous diseases, and considering the surgical procedure itself.

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Normothermia in Breast Reconstruction

Maintaining a normal body temperature during breast reconstructive surgery, especially flap procedures, is crucial for optimal blood flow to the transplanted tissue.

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Dextran in Breast Reconstruction

A drug used to prevent blood clots, but carries risks of blood clotting problems and allergic reactions, not routinely used.

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Patient Positioning Changes

Positioning changes during surgery (supine, lateral, sitting) are crucial for access, assessment of symmetry, and preventing injuries (e.g., brachial plexus).

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Hypothermia Effect on Flap

Low body temperature constricts blood vessels, reducing blood supply to the flap, potentially causing necrosis (tissue death).

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Hypothermia Effect on Hemostasis

Low body temperature can make it harder to stop bleeding during surgery, leading to hematoma formation.

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Hypothermia Effect on Anesthesia Recovery

Low body temperature slows drug removal from the body, delaying recovery from anesthesia and possibly causing issues with metabolism in the liver and kidneys.

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Hypotension in Sitting Position

Rapid shifts from supine to sitting positions can cause low blood pressure in patients, requiring careful and gradual positioning.

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Important Considerations in Arm Positioning

Securing both arms to prevent injuries to the nerves (e.g. brachial plexus, ulnar nerve) as patient is moved during reconstruction is crucial.

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Blood pressure control in TRAM flap

Maintaining mean arterial pressure within 20% of preoperative levels is crucial for adequate blood flow to the TRAM flap tissue to prevent necrosis. Extremes of blood pressure should be avoided to prevent complications.

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Volume replacement & hemostasis

Careful management of fluid volume is necessary to maintain hemostasis during surgery. Albumin can help avoid large crystalloid infusions, while monitoring hemoglobin levels ensures adequate oxygen transport.

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Autologous blood donation risks

Autologous blood donation, while offering an alternative blood source, is associated with a higher risk of postoperative transfusion due to relative preoperative anemia than banked blood.

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Nitrous oxide & TRAM flap

Avoid using nitrous oxide during TRAM flap reconstruction to prevent abdominal distention, which is important for maintaining a good cosmetic outcome.

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Hemoglobin monitoring

Intraoperative monitoring of hemoglobin is essential to ensure adequate oxygen-carrying capacity in the blood.

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Blood product use decision

The decision on whether to give blood, plasma, or platelets during reconstructive surgery depends on the patient's overall health, stability, and surgical outcomes.

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Vasopressor avoidance

Avoid using vasopressors to treat hypotension, as they may reduce blood flow to the surgical flap.

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Fluid management and Albumin

Implementing albumin can manage fluids to help prevent excess crystalloid volume infusion during surgery.

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Postoperative Pain Control

Methods to manage pain after breast reconstruction surgery, including patient-controlled analgesia, epidurals, nerve blocks, and oral medications.

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Long-Term Postoperative Care

Ongoing care needed after breast reconstruction, including potential implant replacements, scar revision, and nipple reconstruction.

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Paravertebral Nerve Block

An injection to numb nerves around the spine, providing pain relief after surgery and improving recovery.

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Breast Implant Replacement

Surgical procedure to replace breast implants that have developed complications like contractures, migration, leakage, or rupture.

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Nipple Reconstruction

Surgical procedures to restore a nipple after breast reconstruction or mastectomy, using techniques such as tissue reconfiguration and tattooing.

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Study Notes

Breast Cancer Overview

  • Over 211,000 women and 1700 men are diagnosed with breast cancer annually.
  • Adenocarcinoma is the most common type.
  • Cellular dysplasia starts in breast duct and lobule cells.
  • Risk factors include family history, nulliparity, early menarche, advanced age, obesity, and personal breast cancer history.
  • BRCA1/2 mutations increase breast cancer risk by 40-85%.
  • Some with these mutations have prophylactic mastectomies.

Breast Cancer Treatment

  • Often treated with surgery, radiation, chemotherapy, and hormone therapy.
  • Breast reconstruction is possible, either immediately or later.

Post-Mastectomy Reconstruction Types

  • Prosthetic implant-based reconstruction.
  • Autologous tissue-based reconstruction.

Factors Influencing Reconstruction Choice

  • Cancer type and location.
  • Resection extent.
  • Patient medical/surgical risk.
  • Desired breast size/shape.
  • Patient preference.

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Description

This quiz covers essential information about breast cancer, including statistics, types, risk factors, and treatment options. It also explores the different types of post-mastectomy reconstruction and the factors influencing the choice of reconstruction methods. Test your knowledge on breast cancer and its management.

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